Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

GUIDE WIRE COPILOT

Facility

$325.00

Service Code	HCPCS C1769
Hospital Charge Code	270682243S
Hospital Revenue Code	278
Min. Negotiated Rate	$7.83
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Commercial	$123.50
Rate for Payer: Aetna Medicare Advantage	$97.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$82.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$82.88
Rate for Payer: Cigna Commercial	$162.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$48.75
Rate for Payer: UnitedHealthcare Community & State	$7.83
Rate for Payer: Wellpoint Medicaid Managed Care	$8.61

GUIDE WIRE COPILOT

Facility

$325.00

Service Code	HCPCS C1769
Hospital Charge Code	270682243S
Hospital Revenue Code	278
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$78.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$65.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$78.65
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$71.50
Rate for Payer: Qualcare PPO/HMO/WC	$48.75

GUIDE WIRE COPILOT

Facility

$250.00

Service Code	HCPCS C1789
Hospital Charge Code	270682243N
Hospital Revenue Code	278
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$125.00
Rate for Payer: Aetna Commercial	$95.00
Rate for Payer: Aetna Medicare Advantage	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$63.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$50.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$63.75
Rate for Payer: Cigna Commercial	$125.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$60.50
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$55.00
Rate for Payer: Qualcare PPO/HMO/WC	$37.50
Rate for Payer: UnitedHealthcare Community & State	$6.03
Rate for Payer: Wellpoint Medicaid Managed Care	$6.62

GUIDEWIRE CRD .018 503-558X

Facility

$560.00

Hospital Charge Code	270624763
Hospital Revenue Code	278
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$135.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$123.20
Rate for Payer: Qualcare PPO/HMO/WC	$84.00

GUIDEWIRE CRD .018 503-558X

Facility

$560.00

Hospital Charge Code	270624763
Hospital Revenue Code	278
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$280.00
Rate for Payer: Aetna Commercial	$212.80
Rate for Payer: Aetna Medicare Advantage	$168.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$142.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$112.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$142.80
Rate for Payer: Cigna Commercial	$280.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$135.52
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$123.20
Rate for Payer: Qualcare PPO/HMO/WC	$84.00
Rate for Payer: UnitedHealthcare Community & State	$13.50
Rate for Payer: Wellpoint Medicaid Managed Care	$14.84

GUIDEWIRE CRD .025 503-539

Facility

$56.00

Hospital Charge Code	270615828
Hospital Revenue Code	278
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$13.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.32
Rate for Payer: Qualcare PPO/HMO/WC	$8.40

GUIDEWIRE CRD .025 503-539

Facility

$56.00

Hospital Charge Code	270615828
Hospital Revenue Code	278
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial	$21.28
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14.28
Rate for Payer: Cigna Commercial	$28.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13.55
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12.32
Rate for Payer: Qualcare PPO/HMO/WC	$8.40
Rate for Payer: UnitedHealthcare Community & State	$1.35
Rate for Payer: Wellpoint Medicaid Managed Care	$1.48

GUIDEWIRE CRD .025 ST 502-549

Facility

$63.25

Hospital Charge Code	270617435C
Hospital Revenue Code	278
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$31.62
Rate for Payer: Aetna Commercial	$24.04
Rate for Payer: Aetna Medicare Advantage	$18.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.13
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.65
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.13
Rate for Payer: Cigna Commercial	$31.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13.91
Rate for Payer: Qualcare PPO/HMO/WC	$9.49
Rate for Payer: UnitedHealthcare Community & State	$1.52
Rate for Payer: Wellpoint Medicaid Managed Care	$1.68

GUIDEWIRE CRD .025 ST 502-549

Facility

$37.75

Service Code	HCPCS C1769
Hospital Charge Code	270617435
Hospital Revenue Code	278
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.66

GUIDEWIRE CRD .025 ST 502-549

Facility

$37.75

Service Code	HCPCS C1769
Hospital Charge Code	270617435
Hospital Revenue Code	278
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.88
Rate for Payer: Aetna Commercial	$14.35
Rate for Payer: Aetna Medicare Advantage	$11.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.63
Rate for Payer: Cigna Commercial	$18.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.66
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

GUIDEWIRE CRD .025 ST 502-549

Facility

$63.25

Hospital Charge Code	270617435C
Hospital Revenue Code	278
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$15.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$12.65
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$15.31
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$13.91
Rate for Payer: Qualcare PPO/HMO/WC	$9.49

GUIDEWIRE CRD .035 150 502-521

Facility

$37.75

Service Code	HCPCS C1769
Hospital Charge Code	270622619
Hospital Revenue Code	278
Min. Negotiated Rate	$5.66
Max. Negotiated Rate	$9.14
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.66

GUIDEWIRE CRD .035 150 502-521

Facility

$37.75

Service Code	HCPCS C1769
Hospital Charge Code	270622619
Hospital Revenue Code	278
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$18.88
Rate for Payer: Aetna Commercial	$14.35
Rate for Payer: Aetna Medicare Advantage	$11.32
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$9.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$9.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$7.55
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$9.63
Rate for Payer: Cigna Commercial	$18.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.14
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$8.30
Rate for Payer: Qualcare PPO/HMO/WC	$5.66
Rate for Payer: UnitedHealthcare Community & State	$0.91
Rate for Payer: Wellpoint Medicaid Managed Care	$1.00

GUIDEWIRE CRD .038 502-525H

Facility

$67.25

Hospital Charge Code	270608951
Hospital Revenue Code	278
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$33.62
Rate for Payer: Aetna Commercial	$25.55
Rate for Payer: Aetna Medicare Advantage	$20.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.45
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.15
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.79
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

GUIDEWIRE CRD .038 502-525H

Facility

$67.25

Hospital Charge Code	270608951C
Hospital Revenue Code	272
Min. Negotiated Rate	$1.62
Max. Negotiated Rate	$33.62
Rate for Payer: Aetna Commercial	$25.55
Rate for Payer: Aetna Medicare Advantage	$20.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.15
Rate for Payer: Cigna Commercial	$33.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$20.18
Rate for Payer: Oxford Commercial	$13.45
Rate for Payer: Qualcare PPO/HMO/WC	$10.09
Rate for Payer: UnitedHealthcare Commercial	$13.45
Rate for Payer: UnitedHealthcare Community & State	$1.62
Rate for Payer: Wellpoint Medicaid Managed Care	$1.78

GUIDEWIRE CRD .038 502-525H

Facility

$67.25

Hospital Charge Code	270608951C
Hospital Revenue Code	272
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$10.09
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

GUIDEWIRE CRD .038 502-525H

Facility

$67.25

Hospital Charge Code	270608951
Hospital Revenue Code	278
Min. Negotiated Rate	$10.09
Max. Negotiated Rate	$16.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.27
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.79
Rate for Payer: Qualcare PPO/HMO/WC	$10.09

GUIDEWIRE CRD .038 503-453E

Facility

$66.45

Hospital Charge Code	270616019C
Hospital Revenue Code	278
Min. Negotiated Rate	$9.97
Max. Negotiated Rate	$16.08
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.62
Rate for Payer: Qualcare PPO/HMO/WC	$9.97

GUIDEWIRE CRD .038 503-453E

Facility

$66.45

Hospital Charge Code	270616019C
Hospital Revenue Code	278
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$33.23
Rate for Payer: Aetna Commercial	$25.25
Rate for Payer: Aetna Medicare Advantage	$19.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.94
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$13.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.94
Rate for Payer: Cigna Commercial	$33.23
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.08
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$14.62
Rate for Payer: Qualcare PPO/HMO/WC	$9.97
Rate for Payer: UnitedHealthcare Community & State	$1.60
Rate for Payer: Wellpoint Medicaid Managed Care	$1.76

GUIDEWIRE CRD EMR .035 401823M

Facility

$89.65

Hospital Charge Code	270623510
Hospital Revenue Code	272
Min. Negotiated Rate	$13.45
Max. Negotiated Rate	$13.45
Rate for Payer: Qualcare PPO/HMO/WC	$13.45

GUIDEWIRE CRD EMR .035 401823M

Facility

$89.65

Hospital Charge Code	270623510
Hospital Revenue Code	272
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$44.83
Rate for Payer: Aetna Commercial	$34.07
Rate for Payer: Aetna Medicare Advantage	$26.89
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.86
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.86
Rate for Payer: Cigna Commercial	$44.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.89
Rate for Payer: Oxford Commercial	$17.93
Rate for Payer: Qualcare PPO/HMO/WC	$13.45
Rate for Payer: UnitedHealthcare Commercial	$17.93
Rate for Payer: UnitedHealthcare Community & State	$2.16
Rate for Payer: Wellpoint Medicaid Managed Care	$2.38

GUIDEWIRE DOC 145cm

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270651827
Hospital Revenue Code	278
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$90.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

GUIDEWIRE DOC 145cm

Facility

$375.00

Service Code	HCPCS C1769
Hospital Charge Code	270651827
Hospital Revenue Code	278
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$75.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$90.75
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$82.50
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

GUIDE WIRE DOC 145CM

Facility

$375.00

Hospital Charge Code	2709001145
Hospital Revenue Code	272
Min. Negotiated Rate	$9.04
Max. Negotiated Rate	$187.50
Rate for Payer: Aetna Commercial	$142.50
Rate for Payer: Aetna Medicare Advantage	$112.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$95.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$95.62
Rate for Payer: Cigna Commercial	$187.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$112.50
Rate for Payer: Oxford Commercial	$75.00
Rate for Payer: Qualcare PPO/HMO/WC	$56.25
Rate for Payer: UnitedHealthcare Commercial	$75.00
Rate for Payer: UnitedHealthcare Community & State	$9.04
Rate for Payer: Wellpoint Medicaid Managed Care	$9.94

GUIDE WIRE DOC 145CM

Facility

$375.00

Hospital Charge Code	2709001145
Hospital Revenue Code	272
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$56.25
Rate for Payer: Qualcare PPO/HMO/WC	$56.25

Know your out-of-pocket cost for care.

All Charges